Lumbar Spondylolisthesis

Condition: Lumbar spondylolisthesis (LS) is the misalignment of one of the bones in your spine (vertebra) relative to another in the lower back. The nerves of the spinal cord can become compressed, causing back pain and numbness or weakness.

Background: LS is categorized based on the underlying causes, including malformations, fractures/microfractures, age-related processes, injury, or other diseases.

Risk Factors: Although women have a lower incidence of fracture-induced disease, women account for more than 50% of symptomatic cases, have more severe disease, and are more likely to have degenerative disease resulting from age-related processes. Family history, race, and participation in gymnastics or football are associated with higher LS risk. Black women are at higher risk than white women, but overall, Inuit people are at highest risk.

History and Symptoms: Patients report diffuse dull lower back pain and may describe pain in the legs as well. If the nerves or spinal cord are involved, the patient may experience tingling, numbness, or weakness in the legs. Bowel and bladder control and sexual function may be affected. Cauda equina syndrome, which involves compression of the nerves at the base of the spine that provide sensation to the legs, is a possible severe complication.

Physical Exam: A physical exam will be performed to assess back pain, curvature of the spine, posture changes, range of motion, alignment of the spine, weakness, numbness, and reflexes. Evaluation of the patient’s walking ability may also be helpful.

Diagnostic Process: X-rays, especially if taken while standing, and CT are used to diagnose LS. MRI can also be used for patients with nerve symptoms.

Rehab Management: Treatment involves relative rest and activity modifications. Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids can be used for pain management. Bracing can also be used, especially in children and adolescents. Rehabilitation includes spinal stabilization exercises as well as physical therapy for stretching and muscle strengthening in the stomach, hip, back, and legs. Epidural steroid injections may be helpful for nerve involvement. Acupuncture and electrical nerve stimulation can also be used to ease symptoms. Surgery is an option in severe cases or those that do not respond to other treatments.

Other Resources for Patients and Families: Patients should be educated on basic spine movements and posture. The progression of the disorder and rehabilitation as well as symptoms that require immediate medical attention should be emphasized.